A cluster-randomised controlled trial of a physical activity and nutrition programme in retirement villages: a study protocol

The retirement village experiential learning journey (RV-ELJ): an Australian "case study" in university course curriculum to reduce ageism and promote working with older adults

BACKGROUND

An aging population means health services are dealing with increasing numbers of older adults, placing challenges on health care systems. Research demonstrates many students who are in the health sciences carry negative views toward older adults, affecting their choice to work with older adults. This study evaluated whether course curriculum via an experiential learning activity that exposed Pre-Medicine students to older adults in retirement villages, improves attitudes to working with older adults upon graduation.

METHODS

A survey using validated tools namely Australian Aging Sematic Differential (AASD); Relating to Older People (ROPE): Reactions to Aging Questionnaire (RAQ); Geriatric Attitudes Scale (GAS) was implemented. Thematic analysis to evaluate students' reflective essays post placement was conducted (n = 11).

RESULTS

There were significant positive shifts in attitudes toward older adults and aging (AASD/GAS), along with improvements in students' self-perceptions of aging supported by qualitative analysis.

DISCUSSION

The results support the need for educational interventions like the RV-ELJ model for reducing ageism and encouraging a mind-set shift toward working with older adults. It is important to expose students to settings where older adults live independently to build rapport and breakdown prejudices and stereotypes. This is likely to encourage interest in working with older adults.

Physical activity and nutrition intervention for Singaporean women aged 50 years and above: study protocol for a randomised controlled trial

BACKGROUND

The majority of the older Singaporean women aged 50 years and above are physically inactive and have unhealthy dietary habits, placing them at 'high risk' of non-communicable diseases (NCDs). The adoption of regular physical activity (PA) and a healthy diet are essential lifestyle behaviours to reduce this risk. This randomised controlled trial (RCT) involves the development, implementation and evaluation of a PA and nutrition programme for community-dwelling Singaporean women who currently attend recreational centres (RCs are public facilities supporting social leisure activities) in their local area. The intervention will be developed after conducting formative evaluation with RC attendees and managers through focus group discussions and pilot testing of resources (i.e. surveys, accelerometers, and health booklets). Programme ambassadors (trained, certified fitness instructors and nutritionists) will deliver all sessions in English and Mandarin; implement classes to meet participants' varying needs; and conduct sessions at different times at convenient venues. Social Cognitive Theory (SCT) has been selected as the theoretical framework to inform intervention strategies as it explores the interactions of human behaviour with the environment and has been found to be valuable when developing behavioural change interventions particularly in older adults (J Gerontol B Psychol Sci Soc Sci 67B(1):18-26, 2012; Obesity Reviews 15(12):983-95, 2014). Its major construct, self-efficacy, is invaluable in achieving successful behaviour change, such as increasing levels of PA or improving dietary intake (Trials. 2017; https://doi.org/10.1186/s13063-016-1771-9 ; Psychol Health Med 18(6):714-24, 2013).

METHODS

The development and implementation of the PA and nutrition intervention strategies will be guided by SCT and Motivational interviewing (MI) and implemented by trained programme ambassadors at the RCs. Sixty RCs located in Singapore will be selected from five major geographical districts and randomly allocated to the intervention (n = 30) or control (n = 30) cluster. A sample of 600 (intervention n = 300; control n = 300) women aged 50 years and above will then be recruited from these 60 centres and only the intervention group will be enrolled into the PA and nutrition intervention. It is hypothesised that by the end of the intervention, the intervention group participants compared to the control group will show significantly greater improvements in the following outcome variables: PA and dietary behaviours, health-related quality of life, objective measures of PA, anthropometric, lipid and glucose profiles. Data will be collected at baseline and 6 months and analysed using mixed regression models.

DISCUSSION

It is anticipated that recruitment, retention and compliance of participants will be challenging due to the target group being unfamiliar with such community-based research programmes.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry, ACTRN12617001022358. Registered on 14 July 2017.  https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372984&isReview=true.

Effects of a physical activity and nutrition program in retirement villages: a cluster randomised controlled trial

Background

This cluster randomised controlled trial aimed to determine if a 6- month home-based intervention could improve the physical activity and dietary behaviours of adults aged 60 to 80 years living in retirement villages located in Perth, Western Australia.

Methods

Participants (n = 363) from 38 retirement villages were recruited into the trial and allocated to the intervention (n = 197: 17 sites) or control (n = 166: 21 sites) group and were blinded. Previously validated instruments-Fat and Fibre Barometer and International Physical Activity Questionnaire, along with anthropometric measures (weight, height, waist and hip circumferences) and blood pressure were collected at baseline and 6 -month time period. Comparisons between intervention and control groups were undertaken pre- and post- intervention using univariate chi-square and t-tests. Multi-level mixed regression analyses were then conducted to ascertain the effects of the intervention on changes in the outcome variables over time and between groups.

Results

A total of 139 (70.5%) intervention and 141 (84.9%) control group participants completed the program and post-test assessments. The intervention group demonstrated significant increases in time (80 min more per week on average) devoted to moderate-intensity physical activity, engagement in strength exercises (from 23.7% to 48.2%), frequency of fruit consumed as well as fat avoidance and fibre intake scores, in addition to a 0.5 kg mean reduction in weight post program, whereas no apparent changes were observed in the control group. Mixed regression results further confirmed statistically significant improvements in weight loss (p < 0.05), engagement in strength exercises (p < 0.001) and fruit intake (p = 0.012) by the intervention participants at post-test relative to their controls.

Conclusions

Retirement offers a time to reassess lifestyle, and adopt positive health enhancing physical activity and dietary behaviours. This intervention was successful in improving weight, engagement in strength exercises, increasing levels of moderate-intensity physical activity and consumption of fruit among retirement village residents. Further investigation is needed on how to better engage retirement village managers in such programs.

Trial registration

Australia and New Zealand Clinical Trial Registry (ACTRN12612001168842) registered November 2, 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0543-6) contains supplementary material, which is available to authorized users.

Community-based physical activity and nutrition programme for adults with metabolic syndrome in Vietnam: study protocol for a cluster-randomised controlled trial

INTRODUCTION

Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular diseases and type II diabetes. In Vietnam, more than one-quarter of its population aged 50-65 have MetS. This cluster-randomised controlled trial aims to evaluate the effectiveness of interventions to increase levels of physical activity and improve dietary behaviours among Vietnamese adults aged 50-65 years with MetS.

METHOD AND ANALYSIS

This 6-month community-based intervention includes a range of strategies to improve physical activity and nutrition for adults with MetS in Hanam, a province located in northern Vietnam. 600 participants will be recruited from 6 communes with 100 participants per commune. The 6 selected communes will be randomly allocated to either an intervention group (m=3; n=300) or a control group (m=3; n=300). The intervention comprises booklets, education sessions, resistance bands and attending local walking groups that provide information and encourage participants to improve their physical activity and healthy eating behaviours during the 6-month period. The control group participants will receive standard and 1-time advice. Social cognitive theory is the theoretical concept underpinning this study. Measurements will be taken at baseline and postintervention to evaluate programme effectiveness.

ETHICS AND DISSEMINATION

The research protocol was approved by the Curtin University Human Research Ethics Committee (approval number: HR139/2014). The results of the study will be disseminated through publications, reports and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12614000811606.